Marathon Challenge: Expert Q&A

Posted 10.30.07

NOVA

Miriam Nelson, who helped advise Team NOVA throughout their marathon challenge, answered a wide range of questions in October and November of 2007. This Q&A could help you safely train for an excercise challenge of your own.

Miriam Nelson

Miriam Nelson, Ph.D., is Director of the John Hancock Center for Physical Activity and Nutrition and Associate Professor of Nutrition at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University. She is author of the international best-sellers Strong Women Stay Young, Strong Women Stay Slim, Strong Women, Strong Bones, Strong Women Eat Well, and Strong Women and Men Beat Arthritis. For the past 12 years, Nelson has been principal investigator of studies on exercise and nutrition for midlife and older adults, work that has been supported by grants from the National Institutes of Health and private foundations. Nelson is a LLuminari health expert. She is also a fellow of the American College of Sports Medicine, an honor reserved for those who have demonstrated superior leadership and research in the field of exercise. Nelson earned her doctorate in nutrition from Tufts.

Q: What steps did NOVA take to make sure that these sedentary people wouldn't get hurt or even die during their training and the race itself? What steps should people training on their own take? Merle L., Somers, New York

Members of Team NOVA received clearance from their personal health-care providers and had additional tests at Tufts to look at their fitness before training for the marathon. The tests included blood work (blood-pressure and cholesterol levels), VO2max tests, and EKGs to monitor their cardiovascular fitness.

In addition, team members frequently consulted their coaches, Don Megerle and Uta Pippig, for advice. The coaches helped teach the runners to safely increase their training mileage and worked with the runners to help them understand the difference between the usual aches and pains of training for a marathon and pain that could indicate a problem. If something seemed wrong, the coaches urged the runners to stop running and see a professional.

People training on their own should follow the same basic steps: consult a health-care provider before beginning a training program, look for a quality training program and follow it consistently, and learn to listen to your body's cues. If something doesn't feel right, don't be afraid to take a couple of days' rest and, if necessary, seek out professional advice.

Q: The recent Chicago Marathon was a frightening reminder of how dangerous running a marathon can be—hundreds of people collapsed, one 35-year-old man died. Shouldn't this be a warning to would-be marathoners? Sally Kopman, St. Louis, Missouri

Every time you take on a physical challenge, there are risks involved. The key is to minimize the risks by taking steps to be sure you are as prepared as possible for the physical stresses of the event. Would-be marathoners should look at the recent Chicago Marathon as an important reminder to take those steps: Be sure you have completed an adequate amount of training before the race, develop a race-day hydration-and-nutrition plan, and most importantly, learn to listen to your body's warning signs. If something doesn't feel right, don't be afraid to stop running.

Like all the members of Team NOVA, check in with a health-care provider before taking on marathon training. This is particularly important for anyone with a personal or family history of heart disease. Unfortunately, even a thorough physical checkup cannot guarantee that a runner will stay healthy. Keep in mind, however, that tragedies like the death in Chicago are rare.

Q: Is running marathons healthy for our bodies in the long run? Some people say it is bad for your joints if you continue to run marathons over an extended period. Anonymous

Every person is built differently. Some people can tolerate many marathons over a lifetime, while others get injured trying to train for their first one. In order to stay healthy in the long run, you should listen to your body's cues—if running starts to be painful, it may be time to cut back on your running mileage and begin to include other types of exercise in your regular routine.

Q: Aside from running, is there anything else one can do to decrease the likelihood of leg/muscle fatigue? My cardio seems fine. However, in runs over 14 miles my legs begin to fatigue in the last three to four miles. Anonymous

Muscle fatigue may be a sign that your muscles need rest! Your marathon-training program should have easy days interspersed with hard days, and it should include one or two days of complete rest each week. (See The Training Calendar for an example.) Without scheduled rest, your muscles will become exhausted from constant intense training, and your running performance will suffer.

You can also consider incorporating resistance training into your exercise program. Building muscle strength in your legs will help keep your legs strong over the course of a long run. Try doing one to three sets of squats or lunges one or two days per week. Plan to have at least one easy day between a resistance-training workout and a hard-running workout, such as an interval workout or a long run.

Q: Two years ago, I jumped off of my sofa, started running, and lost over 20 pounds. But, still, today I can't imagine running a marathon. I have run 5k and 10k runs. But a marathon ... are you kidding me?! I might just die!

It seems that Team NOVA did it using lots of know-how, team work, etc. Do you really think a not-so-fit person could carry out the experience on his or her own using the training these people used? Do you have any suggestions for motivation? I fear that someone needs support and resources to succeed. What would you say? Thank you! P.S. I do not have any running club or facilities around. Anonymous

The motivation that the members of Team NOVA provided for one another was a huge part of their success. Finding a team of your own can help you to be successful, too. Running for a charity program's marathon team is a great way to find motivation. There are many different charity groups located throughout the country. In general, this is how they work: You agree to fund-raise for the charity of your choice and in exchange for your hard work, the charity provides you with expert marathon coaching. Most groups have team runs, led by these coaches, at least once a week. And, if you don't find a charity group in your area, many will provide a virtual team, which allows you to receive the same expert coaching online. For information about charity teams in your area, visit the following sites:

Q: Have there been any studies or conclusive bodies of research done on the effects of diet on exercise performance? I do Ironman triathlons and do quite well, but I don't follow an optimal diet as I'm usually trying to lose weight before big races. Has it been proven that my performance would improve if that one aspect, diet, was changed? Anonymous

It is generally not a good idea to try to lose weight before a big race as it will compromise your glycogen stores and overall nutritional well-being. Research shows that a good nutrition plan will give you more energy to train and can help improve your race performance. You should follow a diet with an adequate amount of calories that emphasizes whole grains, fresh fruits and vegetables, protein-rich foods, and healthy fats. It is also extremely important to refuel after every workout. You should have a snack that contains a combination of carbohydrates and protein (e.g., a peanut butter and honey sandwich or a yogurt) within 20 minutes of exercising. This will help you to restore your muscle's glycogen levels and keep you strong for your next workout.

Q: What is the lactate threshold? Why should we train to "increase" it? And how can we train to improve it? Michael L., 12th grade, Chattanooga, Tennessee

Your lactate threshold is a good indicator of your potential for endurance exercise. It is the intensity during exercise when your body starts to produce lactate faster than it can clear it out; as a result, blood levels of lactate begin to rise, and your performance begins to decline. Increasing your fitness levels through consistent, progressive training, like the training program Team NOVA followed, is the best way to improve your lactate threshold.

Q: What are your suggestions for first-timers training for a marathon in a cold place like Chicago? Running outside during the winter (minus 12°F) is almost impossible. Are there any alternative training exercises we can do? Nai, Chicago, Illinois

Winter running can be really enjoyable if you have the right gear. You need running gear (including a hat and gloves) made of moisture-wicking materials. Such gear can keep you warm even in very cold temperatures. You should visit a specialty running store and work with the staff to help you find the right gear. You will be amazed by how warm you can stay when you are out for a run!

While having the right clothes will prepare you to run in almost any temperature, sometimes the temperature or road conditions make it too dangerous to run. You need to be smart. If the temperature is below zero or the sidewalks are covered in ice, it is best to head inside for your workout. Inside workouts offer you a good opportunity to vary your routine: You can do an interval workout on an indoor track, a hill workout on a treadmill, or give your running muscles a break and do a cross-training session of biking or swimming.

Q: How did the team overcome conflicts with winter weather and availability of daylight, especially since the program appears to be set in the U.S. Northeast? Anonymous

Most of Team NOVA's training indeed took place in the greater Boston area. It can be tricky running in the U.S. Northeast during the winter, and it is important that you consider the lack of daylight when you plan your training. If you have the flexibility, mid-day runs are the best way to fit in a workout during the limited hours of daylight. Otherwise, you need to be creative and ensure that you stay safe. Invest in gear that is reflective. It will help make you visible to drivers. Also, choose routes that have sidewalks along well-traveled roads (save your trail runs for the daytime). Try to run with a friend if you can. Finally, be alert. Don't wear headphones in the dark—you need to be aware of your surroundings at all times. Ultimately, you need to feel safe. If you don't, running inside is always an option!

Q: I am a racewalker. How accurate do you think the Rockport one-mile walk test is for determining VO2max? I have used calculators online that use age and weight and speed. I scored in the superior range, but what is your opinion of the test? I'm 61 and recently walked a 9:55 mile.

My second question concerns your opinion of the Karvonen formula, which uses resting and actual maximum heart rate to determine percentages of maximum heart rate for training purposes. Thank you so much for your time. Jim Herman, Fort Myers, Florida

When performed correctly, the Rockport one-mile walk test, which measures the speed at which you can cover a mile, provides you with a good estimate of your VO2max and overall fitness. The Karvonen formula is also a useful training tool. It is a good way to guide the intensity of your workouts. Relying on how you feel (or your rate of perceived exertion) should also be taken into account when you train. Objective and subjective measurements for assessing intensity are important for maximizing your training.

Q: Is there some place the average person can have their VO2max level tested? Vicky Darden, Lancaster, Pennsylvania

A VO2max test like the one Team NOVA took is not something that is generally offered in doctor's offices. You will need to look for a specialty sports medicine clinic in your area. Such clinics may offer the test for a fee. You can also consider volunteering for a research study. A VO2max test is sometimes part of exercise-based research studies. You can check out current volunteer opportunities at Tufts University: http://hnrc.tufts.edu/studies/

You can get an estimate of your VO2max by taking a variety of different fitness tests that you can perform yourself, such at the Rockport one-mile walk test or Astrand six-minute cycle test. Various health clubs, as well as Web sites, offer instructions for taking these tests.

Q: What are the negatives of marathon-level training? What are the common ailments of old marathon runners? Anish, Royal College, Grade 5, Colombo, Sri Lanka

Marathon training is hard for many reasons. First, it takes a lot of time. People who train for a marathon need to find at least one hour almost every day to train (and longer on the weekends). That can be difficult for people who have jobs and families. Marathon training can also be really hard on your body. Sometimes people's joints and muscles do not put up with the stress of hard training very well.

Older runners often have problems with nagging musculoskeletal injuries. They don't recover as quickly from training as younger runners do. Overall, they usually need to take a few more rest days than younger runners to stay injury-free while training for a marathon.

Having said all of this, there are plenty of marathoners who run multiple marathons over their lifetime and experience no orthopedic problems! A sound training schedule, plenty of rest after races, and an overall healthy lifestyle help to keep marathoners in good shape.

Q: I've run seven marathons in seven years. I have found that whether I run every mile of my training plan (which I did for my first two marathons) or just show up on race day to run 26 miles (which I've done four times—most recently two weeks ago in my local running club's annual marathon) my finish time is always within 15 minutes. It seems I can run at a 10:00 mile pace effortlessly. My best marathon time has been 4:07, and my most recent race—for which I didn't run even one mile in training—was 4:20. Is there any danger to my skeletal well-being heading out for 26 miles untrained? I've been warned about stress fractures and a host of other ailments, but so far so good. I turned 41 this summer. Mentally, I'm comfortable with the distance, and my body seems to be able to manage the feat. Most importantly, I enjoy a year-long sense of accomplishment. As a general rule, I eat well, rest soundly, and stay active daily. I'm considering an ultra-marathon in the future but wouldn't consider that distance without serious training! Does my age send me into a dangerous category? Jeanne Deguire, Albany, New York

Running a marathon in itself does not promote health. Instead, it is the months and weeks of consistent training that create a healthy body. The marathon is a fun way to celebrate how well you have trained. Training for a marathon is absolutely essential; running a marathon without the proper training is extremely risky. Not only are you putting yourself at risk for musculoskeletal injuries, such as plantar fasciitis, shin splints, and stress fractures, you are also risking your life—literally. As Malissa Wood, the cardiologist in "Marathon Challenge," explained in the film: People who haven't trained their hearts to run a marathon are much more likely to experience a heart attack during a marathon than people who exercise regularly. If you don't have the motivation to train properly for a marathon, then you shouldn't risk running one.

Q: I rarely exercise, but I am painfully aware that I should be exercising. For me it's also strangely embarrassing to be seen doing exercise. Do you have any suggestions for someone who has never really exercised and who grew up thinking that exercise is not important—especially for someone over 45—to actually start exercising? Thanks. Peter Manda, New Brunswick, New Jersey

Starting an exercise program can seem overwhelming. The best way to get started is to ease into it. Try out a variety of activities to see which ones you enjoy the most. Consider joining a club or community center that offers exercise programs. Being a part of a club will allow you to meet other people who are in the same position as you. Finding people to share your exercise experiences with you can help to make adopting a lifestyle of physical activity easier and a lot more fun. You will see that your self-confidence soars after you start exercising; the hardest part is the start!

Q: Your calendar shows that you should rest for the remainder of the week following the marathon. What do you do after that? Do you do nothing for the next three months and then start on this same training schedule? If not, at what pace do you continue to train? Anonymous

It is amazing how much damage a marathon does to your muscles! While the soreness usually subsides within a few days, your muscles still need time to recover from all of the stress of the marathon. After you take a few days of complete rest you can ease back into a regular routine of exercise, but don't do any hard running workouts for at least a month. Consider using the first few weeks after your marathon to do some cross training. It is a good chance to give your running muscles a rest and to give yourself a little mental break from running.

Q: I live in northern Minnesota. I run outdoors all year, winter and summer. I had to drop out of my 25th marathon last summer and barely finished my 26th marathon in Chicago last week (yes, I did finish). Both were due to the heat and humidity. This was my 9th Chicago marathon, and I am usually able to make the requalifying time in Chicago for the Boston Marathon, but needless to say, I didn't due to the extreme heat. My body for some reason is unable to take the heat and humidity. By 10 miles my body starts shutting down. I am a seasoned runner, I am a well trained and in great shape for a woman of 51. Why does the heat take such a toll on my body? Is it because of the cold climate up here in northern Minnesota? Is my body that used to the cold? Again I do great in the cold weather. Anonymous

Q: I run in Charlotte, North Carolina. Because of my schedule, I can only run late afternoons. The summers can be quite uncomfortable with high temperatures and humidity. Generally, I run even in the heat. I keep hydrated, slow down, and take walk breaks, but I still find it very difficult to sustain a comfortable pace. I sweat profusely and get diaphragm and leg cramps. Do you have any recommendations for running in hot, humid weather? Bob Morrison, Charlotte, North Carolina

Running in the heat is physiologically different from running in cold weather. Even if you are well trained for cool weather conditions, it does not mean you are well trained to run in hot weather. You need to practice running in the heat for your body to be able to work efficiently in it. If you have not given your body a chance to acclimatize, you will not be able to do your best in a race. I ran the Boston Marathon in 2004 when it was 87°F—a lot warmer than the freezing temperatures I trained through—and I experienced the same thing as you [the runner from northern Minnesota] did in Chicago. The best thing to do is to choose a marathon that will be run in the same conditions that you have trained in. Of course, the weather can surprise you! If you do end up at a race on an unusually hot day, you need to be willing to adjust your expectations. Have a "hot weather" back-up plan: Plan to run slower and hydrate more often throughout the race.

Q: Having completed three sprint triathlons during the summer of 2007, I have already dabbled in competitive sports. If I were to begin training for a marathon next October, where would I begin my training on the calendar provided for the NOVA team? Anonymous

Q: I run four to five miles at a 10:30 pace consistently and did two half marathons this summer in under 2:30 at altitude in Salt Lake City (I had worked long runs up to the distance in advance). The SLC marathon is April 21, 2008. If I want to do it, should I just pick up The Training Calendar schedule at the point where the long runs are four to five miles and go from there? I'm 46 and about 240 lbs and in good health (though I could shed some weight!). My doctor is ok with my health. Philip Lee, Sandy, Utah

You should begin following The Training Calendar at the point where the weekend long run is equal to your current long run distance. Just be sure to figure out how many weeks you have until your event and plan accordingly!

Q: Is it better to run on a treadmill or outside on a sidewalk/road? Emily, Lexington, Kentucky

There are pros and cons to running on any surface. Sidewalks (concrete) and roads (asphalt) can be tough on your knees—in fact, concrete sidewalks are the toughest surfaces for running, but they are everywhere and generally are the only running option for people who run in the city. Treadmills offer a smooth, level surface that is relatively easy on your knees and free from the (sometimes) harsh outside weather. However, treadmills can be boring, and they don't give you a chance to practice real race conditions.

Your best bet is to mix up your running surfaces. Try a few runs a week outside and a few inside. If at all possible, try to run on grass or dirt paths. Those surfaces are most gentle on your knees.

Q: I teach Health and PE. Which is better to increase VO2max in middle-school-age children:

Build up to 10 min runs starting with 3 min the first week and add one min each week until 10 min after eight weeks? Anonymous

Both methods would improve the fitness level of middle-school-age children, but I think that the kids would have more fun doing the interval training. In general, children prefer exercise in short bursts. Making the workouts enjoyable for the kids will keep them engaged and allow them to see that exercise can actually be a fun part of life!

Q: What is a good meal plan for the day before and the day of a 21-mile training run? I tend to overeat both the night before and the day of. Please help! Heather Ashley-Nguyen, Austin, Texas

You do need to have some extra carbohydrates before a long run, but that doesn't mean you should stuff yourself! Think of it this way: Give yourself an extra serving of your carb of choice (e.g., rice, pasta, bread, potatoes) with each meal. That should provide you with enough extra calories and carbs for your long run without making you too full. Another tip is to be sure you don't choose heavy foods. For example, if you have pasta, serve it with tomato sauce instead of Alfredo sauce. And of course, don't forget to have some breakfast the morning of your 21-mile run!

Q: Stretching recommendations are clouded by misconceptions and conflicting research reports. Please give me your thoughts on stretching as part of training for a marathon. Anonymous

Q: Do you recommend stretching and strengthening exercises to complement running? If so, what are some of the "must-dos?" Bing Roenigk, Carrboro, North Carolina

Stretching has become a controversial topic over the years. More and more evidence suggests that stretching may not be essential for preventing injuries; however, engaging in a regular routine of flexibility training is an important part of everyone's fitness regime. It helps to maintain a healthy range of motion for your joints and muscles. I believe all runners can benefit from a regular routine of stretches, specifically for the hamstrings, hips, quads, calves, and low back. Keep in mind: If you are dealing with a specific injury (e.g., iliotibial band syndrome, plantar fasciitis, achilles tendonitis), a stretching routine will be a critical part of your recovery process.

Q: I sometimes get sensitivity in my knees after a run (even if it is only two miles). I have heard that glucosamine chondroitin helps to protect the joints. What exactly is glucosamine chondroitin, and what are its benefits? Also, with so many variations on the shelves, what is the best dosage to take? Gloria, Boston, Massachusetts

Glucosamine and chondroitin are both normal components of cartilage. It is thought that a glucosamine chondroitin supplement can affect the metabolism of specific substances called proteoglycans in the cartilage by decreasing their destruction and increasing their construction. Glucosamine and chondroitin are also thought to have some anti-inflammatory properties. However, it is still not clear whether a glucosamine chondroitin supplement is an effective way to relieve joint pain.

In general, glucosamine chondroitin supplementation appears to be safe—except for people who experience shellfish allergies. If you experience joint pain you may want to give it a try. Most studies have used 1,500 milligrams a day for glucosamine and 1,200 milligrams a day for chondroitin. However, if you haven't experienced relief within a couple of months, you probably aren't going to, and you should stop taking it.

As with any supplementation, it is always best to check in with your health-care provider before you begin to take it.

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Major funding for NOVA is provided by the David H. Koch Fund for Science, the Corporation for Public Broadcasting, and PBS viewers.